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When you think about your upcoming labor, do you
think this is a one in a lifetime event to feel and experience
something only a women can do; similar to a way another would feel
about a marathon or a climb up Mt. Everest. If you feel this
passionate, consider the months of preparation it takes for these
events. If you do not feel this passionate you might consider an
epidural.
Epidural anesthesia has gained considerable popularity in the last
decade. Epidurals are so common that popular women's talk shows make
mention to them on episodes focused on childbirth or babies. If you ever
have an opportunity to see a woman with an epidural, they look totally
free of labor—I can see why so many women want them. For centuries,
physicians have looked for a way for women to have a painless labor.
Historically doctor’s have used ether, gas, and hallucinogenic drugs
to relieve labor pain. All were proven unsafe for mother or baby. The
epidural appears to be the safest to date. But don’t lose common sense—all medication and anesthesia carry a risk.
Epidurals are considered to be a safe option and the anesthetic of
choice of many women who desire relief of pain during labor. It is given
by a trained doctor (anesthesiologist) or nurse–CRNA (certified
registered nurse anesthetist). For the women receiving an epidural, the
preparation may feel no different then getting an IV or having your
blood drawn. The anesthetist will have you lie on your side or sit up on
the side of the bed with your feet dangling or sitting Taylor (Indian)
style. By relaxing and curling your back, you will allow the spaces
between the small bones in the back to open. The back is cleansed with
mild aseptic soap, and a small shot may be given to numb the area. Taking
special care, a needle (shot) is placed between the vertebra. An extremely thin flexible tube (catheter) is threaded through the
needle, and then the needle is removed. The tubing (2 feet long) remains and is
taped to the outside of your back. A syringe with the pain relieving
medicine is attached to the end of the tubing. The medicine will provide relief
from the abdomen to the feet. The medicine can be administered as a
single injection and be given every hour or so, or it can be given in a
continuous infusion through a small computerized pump—both are
acceptable. A test dose of medication is given first to protect you from
any allergic reaction. This may be a different strength of medicine than
the maintenance medication. It will last for a short time as the maintenance mediation takes over, and you
may feel more pressure from the labor as your labor advances. Do not
think the medication is wearing off because of the pressure. If there is
no pain the epidural is working.
Labor effects—usually given during active labor. It diminishes
pain from the waist down. It takes away pain, but you will still feel
the pressure from the baby’s head as it descends and emerges. It is
important that you stay in the position that your anesthetist or nurse places
you, or the epidural may not work properly. Do not raise or lower
the head of the bed because this may alter the level of the medication.
Ask your nurse before changing positions. It may take 10–20 minutes
for the epidural to take effect, but gradually each contraction becomes
less painful—similar to a dimmer switch. The urge to push is
considerably diminished, so the second stage of labor may be longer. It
is not unusual to push for 1–3 hours. Do not get out of bed after
the epidural is placed or during recovery after the birth without your nurse. Your legs may feel normal but they may not be strong
enough to hold your weight. Keep in mind, the cost of the epidural may
be separate from the obstetrical charges.
Research—depending on the research from different teaching
institutes, studies have concluded that epidurals may increase the
length of labor, cause fevers, increase infection rate, and increase
operative births (forceps, vacuum, or cesarean sections). But for many
women it is the pain relief of choice, and they would not trade it for
anything regardless of research.
Side effects—a drop in the maternal blood pressure is the most
common side effect. This will be carefully monitored, and IV fluids will
be increased to prevent this from happening. It can jeopardize the baby due to the decrease blood and oxygen supply to the uterus. Another
side effect is slow labor progress if given in early labor and may hinder the
pushing efforts, making delivery of the baby slower. There are many
other rare side effects that may occur such as ineffective pain relief
or no pain relief, spinal headache, prolonged back ache and even
paralysis. But these are rare. Finally, ask your doctor how they feel
about epidurals. You may be surprised to find out that your doctor
would not consider delivering a baby without one, even if you don't
desire one. Or the flip side might
be your doctor may feel that epidurals are inappropriate for normal
vaginal birth.
Did you know that after
receiving an epidural it is normal to shiver and itch all over
without being cold or allergic.
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